The New Health Care Law and People With Employer Insurance

You can keep the health plan you have now. You will not be forced into a “government” plan—no such plan is offered under the new law. But you will have new protections and options, and other changes might affect you.

New benefits and protections: Starting this September, insurance companies can no longer place lifetime limits (or even annual limits from 2014) on what they will pay for your care. From next January, insurance companies will have to spend a large chunk of the money you pay for your coverage on medical care, not profits or overhead. All new plans must provide many preventive services and screenings for free—but it isn’t yet clear whether this change applies to existing employer plans before 2014.

If you have children: If your insurance offers a family plan, adult children can be covered until they turn 26. No child under age 19 can be denied coverage because of preexisting medical conditions. These changes begin in the fall, but you should consult your insurer to find out which month they take effect for your plan.

New long-term care insurance: Starting next year, if your employer takes part in this program, you can choose to pay monthly premiums through payroll deductions, which after five years entitle you to cash benefits toward the costs of services—from home aides to wheelchair ramps—that help you remain in your home if you are disabled or sick.

If you take early retirement: Starting this June and running through 2013, the government will provide money to help employer health plans cover early retirees ages 55 to 64 and to reduce retirees’ costs.

If you have a flexible spending account: From 2013, the maximum you can contribute to these tax-free accounts (including health savings accounts) will be reduced to $2,500 a year, and you will no longer be able to use them to buy over-the-counter medicines not prescribed by your doctor.

Wellness incentives: Starting in 2013, employers will be allowed to offer employees discounts of up to 30 percent on their insurance costs, if they participate in a wellness program or meet health goals such as quitting smoking.

New coverage options: If your employer coverage is too expensive or too skimpy by new official standards, starting in 2014 you can switch to one of many plans offered through the state-run exchanges and may be able to get subsidies to help you buy that insurance.

If you have a “Cadillac” health policy: Eight years from now, insurance companies must pay an excise tax on the most expensive high-value employer plans. The 40 percent tax applies only to the value of the plan above certain amounts.